Information Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

We respect the privacy of your personal health information and are committed to maintaining our resident's confidentiality. This notice applies to all information and records related to your care that our facility has received or created. It extends to information received or created by our employees, staff, volunteers and physicians. This notice informs you about the possible uses and disclosures of your personal health information. It also describes your rights and our obligations regarding your personal health information.

We are required by law to:

Maintain the privacy of your protected health information

Provide to you this detailed Notice of our legal duties and privacy practices relating to your personal health information

Abide by the terms and Notice that are currently in effect

I. WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES

Facility Directory. Unless you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of clergy and, except for religious affiliation, to other people who ask for you by name. We may also use your name on a nameplate on your door in order to identify your room, unless your notify us that you object.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your personal health information to a family member or close personal friend, including clergy, who is involved in your care.

Disaster Relief. We may disclose your personal health information to an organization assisting in a disaster relief effort.

As Required By Law. We will disclose your personal health information when required by law to do so.

Public Health Activities. We may disclose your personal health information for public health activities. These activities may include, for example:

Reporting to a public health or other government authority for preventing or controlling disease, injury or disability, or reporting child abuse or neglect

Reporting to the Federal Food and Drug Administration (FDA) concerning adverse events or problems with products for tracking products in certain circumstances, to enable product recalls or to comply with other FDA requirements

To notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition or

For certain purposes involving workplace illness or injuries

Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your personal health information to notify a government authority if required or authorization by law, or if you agree to the report.

Health Oversight Activities. We may disclose your personal health information to a health oversight agency for oversight activities or other legal proceedings. These may include, for example, audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment or regulatory programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings. We may disclose your personal health information in response to a court or administrative order. We also may disclose information in response to a subpoena, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.

Law Enforcement. We may disclose your personal health information for certain law enforcement purposes, including:

As required by law to comply with reporting requirements

To comply with a court order, warrant, subpoena, summons, investigative demand or similar legal process

To identify or locate a suspect, fugitive, material witness, or missing person

When information is requested about the victim of a crime if the individual agrees or under other limited circumstances

To report information about a suspicious death

To provide information about criminal conduct occurring at the facility

To report information in emergency circumstances about a crime

Where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your personal health information to a coroner, medical examiner, and funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.

To Avert a Serious Threat to Health or Safety. We may use and disclose your personal health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.

Military and Veterans. If you are a member of the armed forces, we may use and disclose your personal health information as required by military command authorities. We may also use and disclose personal health information about foreign military personnel as required by the appropriate foreign military authority.

Worker's Compensation. We may use and disclose your personal health information to comply with laws relating to workers compensation or similar programs.

National Security and Intelligence Activities Protective Services for the President and others. We may disclose personal health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.

II. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PERSONAL HEALTH INFORMATION

We will use and disclose personal health information (other than as described in this Notice or required by law) only with your written Authorization. You may revoke your Authorization to use or disclose personal health information in writing, at any time. If you revoke your Authorization. We will no longer use or disclose your personal health information for the purposes covered by the Authorization, except where we have already relied on the Authorization.

III. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION

You have the following rights regarding your personal health information at the facility:

Right to Request Restrictions You have the right to request restrictions on the use or disclosure of your personal health information for treatment, payment or health care operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care. We are not required to agree to your requested restriction (except that while you are competent you may restrict disclosures to family members or friends). If we do not agree to accept your requested restriction, we will comply with your request except as needed to provide you with emergency treatment. Requests should be made in writing on Facility provided form: "REQUEST TO RESTRICT USE OR DISCLOSURE OF HEALTH INFORMATION"

Right of Access to Personal Health Information You have the right to inspect and obtain a copy of your medical or billing records or other written information that may be used to make decisions about your care, subject to some limited exceptions. We may charge a reasonable fee for our costs in copying and mailing your requested information. We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to personal health information, in some cases you will have the right to request a review of the denial. This review would be performed by a licensed health care professional designated by Rest Haven - York, who did not participate in the decision to deny. Right to Request Amendment. You have the right to request the facility to amend any personal health information maintained by the facility for as long as the information is kept by or for the facility. Your request must be in writing and must state the reason for the requested amendment, we ask that you use the form provided by the facility: "REQUEST FOR AMENDMENT TO MEDICAL RECORD"

We may deny your request for amendment if the information:

Was not created by the facility, unless the originator of the information is no longer available to act on your request

Is not part of the personal health information maintained by or for the facility

Is not part of the information to which you have a right of assessor

Is already accurate and complete, as determined by the facility

If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.

Right to an Accounting of Disclosures. You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request (not exceed seven years).

We ask that such requests be made in writing on a form provided by our facility: "REQUEST FOR ACCOUNTING OF DISCLOSURES OF HEALTH INFORMATION" Disclosures will not be made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care; disclosures to correctional institutes of law enforcement officials; and disclosures for national security purposes. You will not be charged for your first accounting request in any 12 month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee.

Right to a Paper Copy of this Notice. You have the right to obtain a paper copy of this Notice even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. You may also obtain a copy of this Notice at our Website, www.resthavenyork.com

Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.

IV. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint in writing with the facility or with the Office of Civil Rights in the U.S. Department of Health and Human Services.

COMPLAINT REQUIREMENTS - Your complaint must:

Be filed in writing, either electronically via the OCR Complaint Portal:https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf, or on paper by mail, fax, or e-mail; This email address is being protected from spambots. You need JavaScript enabled to view it., if you need help filing a complaint: 1-800-368-1019

Name the covered entity or business associate involved and describe the acts or omissions you believe violated the requirements of the Privacy, Security, or Breach Notification Rules; and

Be filed within 180 days of when you knew that the act or omission complained of occurred. OCR may extend the 180-day period if you can show "good cause."

To file a complaint with the Facility, contact Terri Anderson, Privacy Officer (717) 843-9866. We will not retaliate against you if you file a complaint.

V. CHANGES TO THIS NOTICE

We will promptly revise and distribute this Notice whenever there is a change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all personal health information already received and maintained by the facility as well as for all personal health information we receive in the future. We will post a copy of the current Notice on the facilities bulletin boards. In addition, we will provide a copy of the revised Notice to all resident's via standard mail.

VI. FOR FURTHER INFORMATION

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact Terri Anderson, Privacy Officer (717) 843-9866.